Bed-wetting is very common. About 5 million kids in the United States wet their bed, including 20 percent of 5-year-olds, 10 percent of 7-year-olds, and 5 percent of 10-year-olds, according to the American Academy of Pediatrics.

The important thing to remember is that bed-wetting (also called nocturnal enuresis) is completely involuntary – your child can't control it. But there are ways you and your child's doctor can help.

Causes of bed-wetting

Why children wet the bed is not fully understood. For most children, bed-wetting is a normal developmental stage and likely related to one or more of these factors:

Your child's body is still developing. It's likely she wets the bed because her bladder, nervous system, and brain are still maturing. You can't rush the physical development needed for nighttime dryness any more than you can rush a first tooth coming in.

Genetics factor in. If either parent experienced bed-wetting, a child is more likely to experience it as well.

Your child produces too much urine at night. His body may not yet be producing enough of a hormone that reduces the amount of urine the body produces at night. While drinking too much close to bedtime can also play a role, restricting fluids does not cure bed-wetting.

Your child sleeps very deeply. Some children are harder to wake than others and may sleep through the signal to the brain that the bladder is full.

Your child's routine is disrupted. Bed-wetting may happen when your child is overly tired, has a minor illness, or feels stressed. A big life change, such a new sibling or school, may make bed-wetting more likely.

There's an underlying medical condition. Medical conditions – most commonly constipation or urinary tract infections, which are easily treated – can sometimes be the cause. Bed-wetting can also be a sign of a more serious health condition, such as diabetes, but that is uncommon. If your child has worrisome symptoms in addition to bed-wetting, call your child's doctor.

What has to happen so my child can stay dry at night?

Think about a potty training timeline having two separate milestones: daytime dryness and nighttime dryness. Most kids are able to stay dry during the day by age 4, but staying dry at night can take months – or even years longer.

Staying dry at night requires your child's brain, muscles, and bladder to mature and work together. It's a more complicated process than staying dry during the day and requires several physical developments:

Your child's bladder needs to have enough capacity to store the urine produced at night.

His body needs to produce a hormone that causes the body to make less urine at night.

The nerves attached to his bladder need to send a strong enough signal to his brain to wake him up and tell him he needs to go to the bathroom.

His muscles need to be able to keep him from peeing until he gets to the bathroom.

When will my child stop wetting the bed?

About 90 percent of children outgrow bed-wetting on their own by the age of 7, according to the American Academy of Pediatrics. That's why most doctors don't routinely suggest bed-wetting treatments, such as a bed-wetting alarm, for children younger than 7.

Unless your child has been dry during the day for at least six months, it may be too soon to expect her to stay dry at night. (Read about signs that you're child may be ready to try regular underwear at night.)

Going back to overnight diapers or training pants, if they still fit and don't leak, can take the pressure off and give your child a chance to mature physically before trying again. Another option is washable or disposable underwear designed for kids who wet the bed. Some come with insertable pads.

It can take some trial and error to figure out what nighttime protection works best for your child, and you may need to adjust as she grows. (One BabyCenter mom used maxi pads in regular underwear as her son got older.)

What practical steps can I take to help my child not wet the bed?

Look at your child's sleeping environment. Is the bathroom a long way from her room, or in an area of the house that she finds scary at night? Ask her gently if there's any reason why she doesn't want to go to the bathroom at night.

If she's afraid of the dark, let her know it's okay to wake you if she needs to go. You can also put a nightlight by her bed or leave a hallway light on.

Keep an eye on your child's fluid intake. It's important that kids drink enough water. The amount of fluids they need depends on things like weather, what they’ve eaten, and how active they are. It's a myth that restricting fluids will make it less likely that he'll wet the bed.

But you can encourage him to drink more early in the day and see if that helps. Aim for roughly 40 percent of his fluid intake in the morning, 40 percent in the afternoon and 20 percent in the evening. Your child may still wet the bed, but he might be less wet.

Make a bathroom stop part of the bedtime routine. Make sure your child goes to the bathroom right before bed, and if she wakes up during the night, ask if she'd like to use the bathroom. Offer to go with her if she's reluctant. However, research shows that waking up a child deliberately to go to the bathroom or carrying her to the bathroom while she's asleep won't cure bed-wetting.

Monitor daytime bathroom breaks. Your child should be going to the bathroom regularly, about four to seven times, throughout the day. If he attends daycare or school, check that he's comfortable using the bathroom there. If he isn't, he may be avoiding drinking and going to the bathroom during the day, and urinating more at night instead.

How can I help my child through bed-wetting?

Stay calm, offer comfort and understanding, and reassure him it's not his fault. Do not blame or punish your child. Bed-wetting is involuntary, and he can't control it. Let him know that lots of kids wet their beds – he's not the only one.

Wait. Unless your child has been dry during the day for at least six months, it may still be too early for her to do the same at night, especially if she's 7 or younger. If your child is regularly waking up to a wet bed, her body is probably not physically mature enough yet. Consider putting her back in overnight diapers or training pants, if they still fit and don't leak, or using washable or disposable underwear designed for kids who wet the bed. Don’t make a big deal of it. Simply tell her in a reassuring way that her body isn't ready to stay dry at night yet.

Try later. Wait until your child is dry most mornings for an extended period of time and then try again when he feels ready. Even another month or two can make a big difference.

Use a reward chart. If your child is 5 or older, a reward chart to track your child's progress may help. Just make sure you reward your child for things she can control. She can't control bed-wetting, so don't reward her for staying dry or take rewards away for wetting the bed.

You could reward her for:

Drinking more in the morning and afternoon and less in the evening, if you find that effective

Going to the bathroom regularly during the day

Going to the bathroom at bedtime

If your child's doctor recommends trying a bed-wetting alarm, you can use a reward chart to track related positive behaviors, such as responding to the alarm quickly.

Talk about how your child feels. Talk openly with your child about how he feels, but don't force him to talk about bed-wetting. If he gets upset, remind him that bed-wetting is common, not his fault, and nothing to be ashamed of.

Bed-wetting often runs in families. If so, share your experience.

Bed-wetting doesn't usually happen as a result of emotional problems, but if your child has gone through a big life change, such as a new sibling or school, he may be more likely to wet the bed. He'll probably stop when things settle down. In the meantime, offer him sympathy and understanding.

Contact your child's doctor. If bed-wetting is causing your child distress, has started after a long period of being dry, or is accompanied by other symptoms, such as pain with urination, talk to his doctor. The doctor can rule out any underlying medical condition, help you manage bed-wetting, and may suggest treatments, such as a bed-wetting alarm.

NICE. 2010. Clinical Guideline CG111. Nocturnal enuresis: The management of bedwetting in children and young people. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/cg111

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